Childhood Eye Care

Eighty percent of everything a child learns is acquired through visual pathways. Development of the visual system - all parts of the eye and the process by which images are taken in by the eye and understood by the brain - is critical if children are to achieve their full potential.

"The pediatric visual system is very different from the adult system," says Dr. Thomas France, UW Health pediatric ophthalmologist. "In the first year of life, the visual system changes dramatically and we are very concerned that it be allowed to develop normally. Anything that arrests that early development can result in permanent damage."

Children's eye exams begin shortly after birth, when the physician checks the newborn for a red glow in the back of the eyes. This "red reflex" test indicates if light rays are entering the eyes properly. Any abnormality should result in an immediate referral to a pediatric ophthalmologist, a specialist in children's eye problems.

Among the most potentially damaging conditions to newborns are Congenital Cataracts (clouding of the lens of the eye), which should be removed as soon as possible.

"If you remove a cataract from an adult eye, vision is restored," explains Dr. France. "But a cataract present at birth or shortly thereafter will interfere with development of the visual system. After a certain period of time - perhaps as short as three or four months - that system will not develop. If you wait until age 2 to remove it, it's too late. Vision is lost and can't be restored."

For babies born very prematurely, the oxygen in the ambient air may be toxic to the eyes, leading to deterioration of the retina (retinopathy) and blindness, if not treated. Fortunately, serious eye conditions such as these are not common and can be treated if detected early.

These conditions are not usually present at birth but may develop during the first year or two of life. Neither condition is common.

With strabismus and amblyopia, it is possible to successfully treat children to age 8 or 9, but it is very important to identify these conditions at an earlier age to ensure better results. Dr. France prefers to correct the situation before a child is 2 if possible, to ensure a more normal development of binocular vision (both eyes working together).

Amblyopia is generally very treatable from age 4 to 8 or 9. Proper treatment at an early age restores vision with little or no loss for the large majority of patients. If Nearsightedness (Myopia) develops, it usually appears around age 8 or 9 years and is generally found by the child's physician or by a school nurse.

Eye Exams by Age 4

All children should have an eye exam by the age of 4 years or younger if there is a family history of significant eye problems. If one or both parents had either strabismus or amblyopia when very young, for example, it's important for their child to have an eye exam in the first year by an ophthalmologist. Children who have severe or unusual problems should see a pediatric ophthalmologist.

Also at risk for vision problems are children with Down syndrome, cerebral palsy or neurological problems. Premature children who do not develop retinopathy still have higher risk for strabismus and amblyopia.

"Every child who needs the services of a pediatric ophthalmologist deserves to see one," says Dr. France.

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